Surgery of the Future Using 3-D

Millions of Americans who are obese find that diet, exercise, and medications are not sufficient to reduce their weight to a healthy level. For many, only surgery may be effective over the long-term. While any type of surgery carries risks of complications, weight loss procedures are becoming safer and more effective. It’s also important to remember that obesity itself carries a high risk of premature death due to obesity-related illnesses, and for many patients, the potential risks from not having weight loss surgery may be greater than the risks from possible complications of having the procedure.

“Weight loss surgery, otherwise known as bariatric surgery, is not for everyone. However, according to a National Institutes of Health consensus statement, weight loss surgery is the only treatment proven to consistently achieve long-term weight loss in the severely obese,” says Linda Trainor, the Bariatric Nurse Coordinator and the Chief Editor of Beth Israel Deaconess Medical Center’s Weight Loss Surgery online newsletter.

One type of new surgical method that is gaining popularity is laparoscopic sleeve gastrectomy, in which a surgeon uses a laparoscope to remove 60% to 80% of the stomach and create a small sleeve-shaped pouch. The procedure is effective because the smaller size of the stomach restricts the amount of food that a person can eat.

“Laparoscopic sleeve gastrectomy is fast becoming the weight loss operation of choice as more and more insurance companies cover the procedure,” says Dr. Dan Jones, Chief of Minimally Invasive Surgery and Director of the Weight Loss Surgery Center at Beth Israel Deaconess Medical Center. “The sleeve trims the stomach down from the size of a cantaloupe to the size of a banana.” Many patients drop 80 to 100 pounds.

Whereas gastric bypass surgery—the current gold standard for weight loss surgery—involves reducing the size of the stomach and reconnecting it in a way that bypasses the first portion of the small intestine, gastric sleeve does not involve any bypass of the intestinal tract. Also, the outlet vale and the nerves to the stomach remain intact, which reduces patients’ risk for anemia, osteoporosis, and vitamin deficiency. “There’s no malabsorption issue like gastric bypass,” says Dr. Jones. He also notes that along with the removal of most of the stomach, sleeve gastrectomy removes some of the cells that send hunger signals to the brain. This can be particularly helpful for patients who have trouble getting their eating under control.

Another option is the laparoscopic adjustable gastric band procedure, during which a surgeon makes several small incisions in the patient’s abdomen and places an adjustable band around the upper portion of the stomach. The newly created upper pouch allows the patient to consume only small amounts of food at a time. “Patients often like this procedure because they have the ability to control the adjustable band,” says Dr. Robert Andrews, a surgeon at the Weight Loss Surgery Center who also practices at Beth Israel Deaconess Hospital-Milton. “Also, it doesn’t permanently change anatomy,”

Beth Israel’s Weight Loss Surgery Center also offers robotic surgery—whereby a physician uses a computer to remotely control very small instruments that perform surgery. “No matter how the weight comes off, though, diabetes, knee pain, back pain, sleep apnea, and high blood pressure get better for patients,” says Dr. Jones.

Both Dr. Jones and Dr. Andrews stress that patients play an important role in achieving these outcomes, and undergoing weight loss surgery does not take all of the responsibility off of patients. “Surgery is a tool, but patients must be committed to having a well-balanced diet afterwards, which they can achieve with the help our nutritionists and others in our educational program,” says Dr. Andrews.